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A new Republican proposal could reshape Medicaid, the government-funded health program that provides coverage to millions of low-income Americans. Lawmakers are considering adding work requirements to Medicaid, a move that could result in millions losing access to essential health care.
While ers argue this would encourage employment and reduce federal spending, research suggests it may instead lead to widespread coverage losses without increasing workforce participation.
What are Medicaid work requirements?
Medicaid work requirements would mandate that certain adults prove they are working, searching for a job, or participating in approved activities, such as job training, as a condition of maintaining health coverage.
A bill introduced in early 2025 proposes implementing these requirements at the federal level.
If ed, states would be required to enforce them, or they could pursue similar policies independently through special waivers.
A previous attempt to impose work requirements in Arkansas led to more than 18,000 people losing coverage in less than a year.
Most of those affected were already employed or qualified for exemptions but failed to navigate the complex reporting process.
This pattern could repeat nationwide if new requirements take effect.
Many Medicaid recipients already work, often in low-wage industries where employer-sponsored health insurance is not an option.
Among non-disabled adults under age 65 on Medicaid, 92% are either employed, caring for dependents, attending school, or facing health limitations that prevent them from working.
The remaining 8% report reasons such as retirement or an inability to find work.
Critics argue that instead of incentivizing employment, work requirements would create istrative hurdles that strip coverage from people who need it most.
A Congressional Budget Office (CBO) analysis found that a national Medicaid work requirement could result in 1.5 million people losing coverage annually while failing to increase employment rates.
Financial and health impacts of Medicaid work requirements
ers of work requirements claim they could help reduce Medicaid spending, which currently costs taxpayers $880 billion annually.
However, past attempts have shown that these policies are expensive to implement.
Arkansas's system required extensive istrative resources, and Georgia's current program has cost over $40 million, with most of the funds going toward istrative expenses rather than direct health care.
Additionally, losing Medicaid coverage can have long-term consequences.
Studies show that access to affordable health care helps people stay employed by managing chronic conditions and mental health issues.
Without coverage, individuals are more likely to delay necessary care, leading to worse health outcomes and greater financial strain.
While Congress debates nationwide implementation, some states may pursue their own policies through waivers.
Past legal battles over these requirements suggest that court challenges are likely if new measures are enacted.
With millions of lives and billions of dollars at stake, the debate over Medicaid's future is just beginning.